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The Senate health bill takes what Americans hate about Obamacare and makes it worse

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Wouldn’t it be easier just to cut taxes?

The Senate GOP’s health care bill is a strange document. It doesn’t fix what conservatives dislike most about Obamacare. But it takes what everyone else hates about Obamacare and makes it much, much worse.

The plan keeps Obamacare’s basic structure intact. The tax credits remain tied to income. Many of the insurance regulations remain in place. Medicaid is, in theory, gutted down the road, but the cuts don’t even begin until 2021 — raising the fear for conservatives that they’ll never happen at all. Even the cost-sharing reductions to insurers — which Republicans bemoaned as an illegal “bailout” — are restored.

So Obamacare — the government program that makes it the state’s responsibility to cover people with health insurance — mostly survives. If you are a conservative angry that the federal government has created a new health care entitlement, this bill doesn’t solve your problem.

But under the Senate bill, Obamacare’s ability to actually cover people with health insurance is sharply diminished. Because the plan shifts hundreds of billions of dollars in insurance subsidies to tax cuts for the wealthy, there’s not enough money in it to cover nearly as many people, with nearly as good insurance, as there is now.

So Obamacare — the program that got more than 20 million people onto (usually) decent health insurance — is gutted. If you are a liberal who supports the Affordable Care Act because it improves people’s lives, this bill will infuriate you.

The new world created by the Senate health care bill will be based around higher-deductible plans that cover fewer health benefits and cost people more. The plan degrades Obamacare’s insurance regulations, and cuts insurance subsidies so that Americans won’t be able to afford plans as generous as the ones they purchase now. If the Medicaid expansion really does die out in 2024, then the poorest of the poor will be pushed from comprehensive, low-cost health insurance to extremely high-deductible plans.

So if you, like most Americans, think Obamacare does some good, but it doesn’t cover enough people, and the people it does cover are paying too much to get too little, you are going to hate this bill.

Who, then, is this bill actually supposed to make happy? Well, if all you really cared about was cutting taxes for rich people and creating the tantalizing prospect of taking Medicaid away from poor people down the road, this bill is for you.

If you thought Obamacare more or less made sense, but the problem was the insurance it offered was too affordable and too good, then this bill definitely works for you.

If you’re Mitch McConnell, and you were looking for something, anything, that could either pass quickly or be killed quickly, this bill might be for you.

But if you’re like most people and you just want to see the health care system made better — if you want people to be able to afford insurance that protects them and their families — this bill is a disaster. Its theory of insurance is there should be less insurance coverage. Its theory of insurance design is insurance should cover fewer medical expenses and carry higher deductibles. Its theory of cost control doesn’t exist. Its theory of stabilizing insurance markets is to shovel subsidies directly to insurers as a payoff for participating. Its theory of the system overall is that we spend too much money on health insurance for poor people and too little money on tax cuts for rich people.

This is a bill designed to solve a political problem Republicans have: They need to do something they can call “repeal and replace” of Obamacare. But its passage would create a much bigger political problem for them: They will own an unstable health care system that people hate.

Wouldn’t it be easier just to cut taxes?

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mareino
5 hours ago
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My current pet theory is that this is the bill that Chuck Grassley wanted to write in 2009. It keeps all the complicating structures from Obamacare but strips out the results that those structures were invented to accomplish.
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This is the biggest pure giveaway to the rich in the Republican health bill

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An incentive for time-traveling job creators.

Senate Republicans’ Better Care Reconciliation Act contains many provisions that cut taxes on some of the most affluent households in America.

The single biggest tax cut of the bunch applies exclusively to individuals earning more than $200,000 a year or married couples with combined incomes of more than $250,000. It’s a 3.8 percent tax on net investment income (basically capital gains or dividends) that applies only if your total income is over those threshold points.

But not only does the bill repeal that tax, it repeals it retroactively, to give rich families a tax break on investment income accrued earlier this year as well as investment income going forward.

The dollar amount involved in the retroactivity provision isn’t all that large in the grand scheme of things, but conceptually it’s very significant. That’s because there are two basic reasons one might object to the net investment income tax.

One is what you might call the moral objection. Some people believe that, morally speaking, it is wrong that rich American families have so little money. The country would be a better, more just place if Congress acted with more concern for the interests of the wealthiest among us and made sure the incomes of the highest-income families went up.

The other is what I’d call the growth objection. Some people believe that, economically speaking, taxes on investment income hurt almost everyone’s interests in the long term. Lower taxes on investment income will lead to more investment, and ultimately more jobs and growth.

The key thing here is that there’s absolutely no reason to think a retroactive tax cut will boost job creation and growth. You’re essentially increasing people’s incentives to travel back in time and create jobs earlier in the year. Or, rather, you’re not increasing anyone’s incentive to do anything. You’re just shoveling money into the pockets of the least needy families in the country.

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mareino
6 hours ago
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Metro’s schedules aren’t as realistic as they should be

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It’s not possible for trains to get from one end of their line to the other in the time Metro’s schedules say they do. In fact, Metro’s Trip Planner tool underestimates actual travel times by about 10 percent. One upside of Metro’s coming schedule changes, which go into effect on June 25, is that its schedules will be updated to be more accurate.

Metro’s trains usually run from all the way from one end of a rail line to the other. The time it takes the train to complete its scheduled trip is called its “run time.” According to data collected in February and March by MetroHero, a Metrobus/Metrorail transit app that crunches Metro’s train data, Metro’s Trip Planner underestimates end-to-end run times by about 10 percent.

For instance, Metro’s Trip Planner says it takes an Orange Line train 57 minutes to travel from Vienna to New Carrollton, or vice versa. But that essentially assumes that the trains are running faster than they actually are. It actually takes Orange Line trains about 61.5 minutes to make that trip, which is 4.5 minutes longer than what the schedule says, or about 7.9 percent more time.

A comparison of the schedule travel time to the actual travel time.  Data provided by MetroHero during the February 28th 2017 to March 4th 2017 time period. Data availability was limited due to the  various severe service impacts and changes caused by SafeTrack. Image by the author.

A schedule that doesn’t match reality is bad for Metro’s ability to space trains. Assuming trains run six minutes apart when in reality they’ll always end up bunching means more stopping in tunnels and at stations.

Also, the fact that trains actually travel slower compared to what the schedule assumes means “extra” trains end up in service. This is because when it’s time for a train to depart New Carrollton but that train hasn’t yet arrived from Vienna, the westbound trip is either delayed, skipped, or another train has to be put into service.

It’s no wonder that trains fall behind how long passengers expect their travels to be. The expectations that Metro has set don’t meet what they can deliver anymore.

Metro will adjust its published runtimes starting June 25th

Several changes take effect on Sunday, June 25. And with those, Metro is updating its runtime schedules to more accurately reflect how long it takes trains to get from end to end.

  • Red Line runtime will go up from 62 to 70 minutes
  • Orange: from 57 to 61
  • Yellow: 27min from Huntington to Mount Vernon
  • Green: 51 minutes, up from 48
  • Silver: 71, up from 70
  • Blue: 68 minutes from Franconia to Largo, up from 64

Changes in how Metro schedules trains should  also help alleviate some of these issues. Trains will come less often, going from running every six to every eight minutes, but that should mean that Metro can more reliably make trains arrive when the schedule says they’ll be there.

So even while there’s still plenty of work for Metro to do in providing quick rail service, the agency should at least be able to provide timely rail service.

Part of the reason trains are slower: manual train operations and speed restrictions

There are underlying reasons why runtimes aren’t as fast as Metro currently says they are.

Before the Fort Totten crash in 2009, most Metro trains were operated in Automatic Train Operation (ATO) mode, meaning the train computer would handle driving from one station to the next. A second system would immediately automatically open the train’s doors when the it came to a proper stop in a station. Both of these systems have since been disabled, and as a result trains take longer to travel between stations and also waste time sitting at stations.

The automatic door feature, where the doors would automatically open when a train berthed in a station, was disabled in 2008. Instead of opening immediately, the doors remained closed while the train operator walked across the cab and pushed a button. This added a few seconds of delay. Later, after several incidents where operators opened doors while their 8-car train was stopped at the 6-car marker, Metro replaced this with the Three to Five Second Rule.

Under this policy, train operators are required to look out the side window of the operating cab for at least three to five seconds before opening the doors. Those few seconds at each station add up, and were never accounted for in the train’s runtime. So by operating a train normally, an operator is almost expected to fall behind schedule.

Trains were also switched out of ATO mode so the human operator drives the train instead of the computer. A human isn’t able to depart a station, drive to the next one, and stop a train as efficiently as a computer; we just can’t react as fast. So the computer is more able to maintain steady, constant speeds based on what the track speed limits allow for. This inefficiency causes additional time to be spent in transit.

Track speed limits have also been reduced across the system. Metro trains are capable of operating safely at up to 75 miles per hour, and some portions of track (like Spring Hill to Wiehle on the Silver Line) are capable of allowing trains at that speed. However, for decades, WMATA has limited speeds to 59mph over most of the system, except for a few portions of the Green Line, which allowed for 65mph operation.

After a Yellow Line train had a near-miss with a group of Metro and FTA track inspectors, the agency announced it would limit maximum train speed to 59 mph on all tracks system-wide, which adds additional times to trips that the schedule doesn’t account for. An increased number of speed restrictions placed due to track defects have also slowed trains down, as has a policy of limiting Red Line trains to 45 mph to reduce strain on the power system at all stations between Grosvenor and Union Station.

With fewer trains running on just about all lines, it's that much more critical for Metro to show that it can keep trains on their schedule and make sure that trains come when they should be. Metro's customers have put up with a lot; reliable service delivery is not that much to ask for.

Top image: Passenger Information Display System at Metro Center during a track shutdown between Smithsonian and Federal Center SW, March 2017. Photo by the author. Image by the author.

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mareino
9 hours ago
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It's better than the old system of telling itself pretty lies, but it's depressing to see the official data on just how much less capable Metro is without automation. This is what the productivity gains from computers look like in reverse.
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Breakfast links: Metro’s new hours hurt service industry and hospitality workers

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With Metro’s shorter hours, a new reality sets in for workers

Metro's shorter opening hours mean those who work late at night will be in a bind. Some are using Uber more often, a pricier alternative that they may not be able to afford or sleeping in the back room until the system opens again.  (Martin Di Caro / WAMU)

Fewer zoning restrictions could create better housing and job opportunities

Ilya Somin, a GMU law professor, discussed the increasing agreement between libertarians and progressives that onerous zoning is harmful to the economy, citing research that reductions in zoning might increase the country's GDP by 9.5%.   (Ilya Somin / Post. Tip: Steve S.)

Live free and ride hard: Montgomery County extends trail hours

To encourage bike commuting, Montgomery County will be changing the long-standing hours of "sunrise-sunset" for their trails to 5 am to midnight, with the option to modify the hours at specific trails as it deems necessary.  (WashCycle)

Driver-focused changes coming to Uber

Uber is taking steps to address long-standing complaints from their drivers.  Chief among them, tips will now officially be part of the app by the end of July, and customers will have a shorter window to cancel trips.  (Jay Barmann / SFist)

Arlington gets a new ride-hailing app: Sprynt

A new ride-hailing service that uses large electric golf carts to ferry its passengers began operating in Arlington on Wednesday.  Though small (its current fleet has only four vehicles). the company does plan to expand throughout the area.  (Sara Gilgore / WBJ)

Capital Bikeshare is seeking a sponsor

Capital Bikeshare is looking for an official corporate sponsor to help fund the bikeshare program. CaBi will likely choose the sponsor by early next year, with initial estimates of around $750,000 in funding for the program.  (Patricia Sullivan / Post)

This Kmart blocks an entire street in Minneapolis

Back in the 1970s Minneapolis made a desperate deal that allowed Kmart to build a shopping center right in the middle of a busy thoroughfare.  Now the city is finally fighting to get it moved, but may not have the legal right to do so until 2053.  (Laura Northrop / Consumerist)

Uber’s CEO steps down, but will still have a role in the company

Uber's CEO Travis Kalanick has stepped down from his position after being asked to do so by several key investors in the company.  The investors are now seeking new leadership to move the company forward. He will remain on the board of directors.  (Jay Barmann / SFist)

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mareino
9 hours ago
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The Kmart story is an insane example of dumb government deal making.
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Voting Rights Defeatism is Toxic – Talking Points Memo

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Over the last two days I’ve seen several mentions of one argument about what happened in the Georgia 6 special election. Simply, it goes like this: Democrats were stupid because it was obvious they wouldn’t win as long as so many potential voters were disenfranchised either by felony disenfranchisement, onerous voter ID laws, permissive voter roll purges or other laws that limit voting. Nothing will change until that changes.

This is profoundly misguided and demoralizing when it comes to the effort to actually bring about change.

Let me start by saying this. I think I am on strong ground in saying there is no publication in the United States over the last two decades which – relative to staff size – has devoted more resources to reporting about voter suppression in its numerous legal and sub-legal guises. I would even say that some of the best reporting at other publications has been done by reporters who learned the story working at TPM. My point here isn’t to brag or say we’re the only ones on this (not remotely true) but to establish what I think is our demonstrated focus on this issue over many years, proof in focus and commitment of how important we believe this issue is in American public life.

But the simple fact is that Democrats or anyone who believes in voting rights will need to win elections under the current restrictive system to be able to change laws to change that system. The fact that that is challenging and unfair doesn’t change the reality of it. There’s no getting around this basic fact.

Lawyering and lawsuits of course play a critical role but as I think the vast majority of civil rights lawyers will tell you, lawsuits are inherently limited in their ability to effect change. They are most potent in limiting the destructive effect of restrictionist legislation by running them through the obstacle course of constitutional prohibitions. At the end of the day, however, judges are appointed by elected officials. So there are profound and inherent limitations on what can be accomplished in the courts.

I think most people who are concerned about this issue and are working for change will recognize what I’m saying and agree with it. It’s not that I think I’m the only one who’s thought of this. But the way this is messaged creates a toxic form of  defeatism about the possibility and necessity of winning elections in the restrictionist system to be able to be able to change the system.

Elections can definitely be won under the current voting regime. Is it harder for Democrats? Yes. Is it fair? No. But lots of things aren’t fair. This is one of them.

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satadru
1 day ago
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Yup.
New York, NY
mareino
9 hours ago
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LOL Nothing Matters

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The AHCA is despised by the public and opposed by most interest groups. Why is there a good chance it will pass the Senate? I think this is exactly right:

Since taking office, his signature values — showmanship, shamelessness, and corruption — have spread like kudzu in official Washington. It’s now a country where Cabinet secretaries go on television to lie and claim that a $600 billion cut to Medicaid won’t cause anyone to lose coverage. It’s a country where the speaker of the House introduces an amendment to erode protections for patients with preexisting conditions and then immediately tweets that it’s just been “VERIFIED” (by whom?) that the opposite is happening. Republican senators who a couple of months ago were criticizing the House bill’s Medicaid cuts as too harsh are now warming up to a Senate bill whose cuts are even harsher.

The watchwords of Trump-era politics are “LOL nothing matters.” If you’re in a jam, you just lie about it. If you’re caught in an embarrassing situation, you create a new provocation and hope that people move on. Everything is founded, most of all, on the assumption that the basic tribal impulses of negative partisanship will keep everyone on their side, while knowing that gerrymandering means Republicans will win every toss-up election. If you happened to believe that Republicans in office would deliver on their health care promises, well, you might be interested in a degree from Trump University.

And, again, the structural advantages Republican have are a huge part of the story. It’s not that public opinion won’t affect voting behavior at all. It’s just Republicans can afford to be more unpopular because of how severely instutitions are tilted in their favor.

Another point worth making is that while Trump is the vulgar, transparent face of dishonesty and norm destruction, McConnell is the more crucial evil genius. His crucial insight is that you can systematically violate norms without paying much or any electoral price. This should probably be a separate follow-up to Dan’s excellent post below, but McConnell putting party above country when shown clear evidence of Russian election subversion is the ultimate example. Trump is more a logical culmination of McConnell’s Republican Party than an accident. And this is part of the reason why the idea that Trump would be the Republican Carter — the end of a political coalition — is so deeply misguided.

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satadru
5 hours ago
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New York, NY
mareino
11 hours ago
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